《当代中国人口与发展》2023年第1期

Justine Coulson, Vinit Sharma & Hua Wen Understanding the global dynamics of continuing unmet need for family planning and unintended pregnancy

Family planning is regarded as one of the major public health successes in the past 70 years. Worldwide, the contraceptive prevalence rate (CPR) for women of reproductive age rose from 28% in 1970 to 48% in 2019 and demand satisfied rose from 55 to 79% in the same time period (Haakenstad et al., 2022). Family planning offers both health and social benefits for women. It saves lives by preventing unintended, unwanted and unplanned pregnancies thereby reducing the need for abortions (that can often be unsafe and illegal) and also by reducing the probability of a woman’s death because of causes related to pregnancy and childbirth. In 2022, use of contraception averted more than 141 million unintended pregnancies, 29 million unsafe abortions, and almost 150,000 maternal deaths (United Nations Population Fund [UNFPA], 2022a). A number of research studies have documented that women who have planned and adequately spaced pregnancies give birth to healthier children and evidence also shows that expanding contraceptive use can lead to improvements in women’s agency and labour force participation.

Universal access to family planning is a human right, central to gender equality and women’s empowerment, and a key factor in reducing poverty and achieving the goal of Universal Health Coverage (UHC) (Prata et al., 2017). It is a very cost-effective public health intervention because of the high returns that it yields. Every US$1 invested in meeting the unmet need for contraceptives can yield up to US$120 in accrued annual benefits in the long-term; US$ 30–50 in benefits from reduced infant and maternal mortality and US$ 60–100 in long-term benefits from economic growth (FP2020, 2018).

Unmet need refers to women of reproductive age who wish to avoid a pregnancy but are not using a contraceptive method. Despite the multiple benefits of family planning and improvements in access, in 2019, an estimated 160 million women and adolescents globally had an unmet need for family planning with over half of the women with unmet need living in Sub-Saharan Africa and South Asia (Haakenstad et al., 2022). High unmet need leads to high rates of unintended pregnancies and the links between unmet need for family planning, unintended pregnancies, and unsafe abortions leading to maternal deaths, is well established. Terminations of pregnancies indicate a high unmet need for contraception, and unintended pregnancies have been identified as the underlying cause for nearly all abortions, many of which are performed illegally and under unsafe conditions.

Adolescent girls are a group that globally have substantial unmet need for contraception that results in adverse health effects and negative consequences for their development. In low- and middle-income countries (LMICs), unmet need for modern contraception is disproportionately higher among adolescent girls aged 15–19 (43%) than amongst all women aged 15–49 (24%). Adolescents in LMICs have an estimated 21 million pregnancies each year, of which approximately 50% are unintended, and 55% of unintended pregnancies end in abortions, which are often unsafe (Sully et al., 2020). Consequences of unintended pregnancies for adolescent girls can be far-reaching, including school dropout, poor sexual and reproductive health, cultural stigmas and social pressures, as well as lost opportunities for employment and income in the long term.

Whilst this Special Issue uses the standard definition of unmet need, in recent years there has been increasing debate amongst academicians and practitioners regarding the limitations of the term. For example, unmet need does not measure whether or not a woman wants to use a contraceptive method, yet half of the women classified as having an unmet need report that they do not want or intend to use a contraceptive method in the future. Should non-contraceptive use amongst these women be classified in the same way as those women who do express a desire to use a contraceptive method? (Fabic, 2022). There is also a concern that the measurement of unmet need refers to ‘sexually active women’ which suggest frequent, regular sexual activity which does not adequately capture the needs of unmarried adolescent girls in temporary or short-term unions. Furthermore, some researchers are now questioning the definition because it assumes that all women who are using a method have had their specific needs met. However, the current definition undercounts the number of women with a true unmet need for contraception as it misses the many women who are using a method that does not meet their preferences. (Rominski & Stephenson, 2019).

Website of the paper https://link.springer.com/article/10.1007/s42379-023-00130-7

Hui Wang, Yanhui Zou, Hongyan Liu & Xueqian Chen Analysis of unintended pregnancy and influencing factors among married women in China

Abstract Unintended pregnancy often ends with induced abortion, an outcome that affects a woman’s physical and mental health and consumes social resources. A national fertility survey conducted by the former National Health and Family Planning Commission in 2017, gathered data on pregnancies among married women aged 15–49 to analyze the changing circumstances of such pregnancies and the factors that influence their occurrence. The analysis found that the incidence of unintended pregnancies among married women in China was 42.4‰ in 2017, and that such pregnancies accounted for 22.9% of all pregnancies in China for the years 2010–2017. Of all abortions, 91.9% were used to terminate unintended pregnancies, and of unintended pregnancies, 67.1% ended with induced abortions. The incidence of unintended pregnancy and that of induced abortion to terminate the unintended pregnancy were higher among women living in an urban rather than a rural area, having previously given birth to a boy, having a large number of children, being at the older end of their childbearing years, or having a shorter interpregnancy interval. Only 37.3% of women chose long-term contraceptive methods after an induced abortion caused by an unintended pregnancy; their sense of self-protection was not strong. It is necessary to strengthen education and advocacy, enhance women's awareness of the protection contraceptives offer, and improve the quality of and access to contraceptive services to reduce the incidence of unintended pregnancy, and reduce the incidence of induced abortion to terminate unintended pregnancy.

Keywords Unintended pregnancy·Induced abortion·Influenced factor·Married women

Website of the paper https://link.springer.com/article/10.1007/s42379-023-00126-3

Innocent Modisaotsile, Maria Stacey, Willis Odek, Daughtie Ogutu & Rosemary Kindyomunda Heightened risk of unintended pregnancy among sex workers and sex worker organizations’ response during the stringent COVID-19 containment measures in East and Southern Africa

Abstract The UNFPA 2022 State of the World Population (SWOP) report recognises that certain populations of young women and girls are at a higher risk of unintended pregnancy, but did not adequately address the grave situation of female sex workers (FSWs), who experience the worst sexual and reproductive health outcomes, especially during humanitarian crises. This study assesses the risks of unintended pregnancy among FSWs and sex worker organizations? response during the stringent COVID-19 containment measures in East and Southern Africa (ESA). A mixed-methods approach consisting of a desk review, key informant interviews and an online survey was used for data collection. Key informants and survey respondents included representatives of sex worker-led organisations and networks, organisations providing services to sex workers, development partners, advocacy organisations and donors, with priority given to key informants who had direct experience of providing services to sex workers during the COVID-19 pandemic. In total, 21 key informants were interviewed and 69 respondents participated in the online survey, with representation from 14 out of 23 countries in the ESA region. The study findings show that the disruption to livelihoods and threats to human rights occasioned by the stringent COVID-19 containment measures intersected with sex workers’ access to contraception and risk of unintended pregnancy. Looking to the uncertain future of humanitarian crises, the study concludes by outlining critical issues that need to be addressed to ensure resilience of SRHR services for populations in vulnerable positions, such as sex workers.

Keywords COVID-19·Female Sex Workers·SRHR·Unintended pregnancies·Access

Website of the paper https://link.springer.com/article/10.1007/s42379-023-00128-1

Yu-Yan Li, Yan Che & PPC Study Group Unmet need for postpartum family planning and influencing factors in China

Abstract To explore the rate and influencing factors of unmet need for postpartum family planning (PPFP) in China. We conducted a retrospective cohort study at 60 hospitals in 15 provinces that were in eastern, central, and western regions of China. Participants were women who delivered a live birth at the study sites with an interval of 13 to 24 months between delivery and interviews. We selected participants using cluster randomization approach, and the first 300 postpartum women who gave a birth at each study hospital after the initial month that had been selected were interviewed. Information on the women’s background characteristics, pregnancy history, time when menstruation and sexual activity resumed after childbirth, the adoption of contraceptive method, breastfeeding, and any pregnancy or pregnancy outcome after delivery were collected. We performed life-table analysis to estimate the rate of unmet need for PPFP and a 2-level logistic regression model to explore factors that influence unmet need for PPFP within the first 24 months postpartum. A total, 19,939 postpartum women were screened in this study, of which, 17,466 (87.6%) were eligible for this analysis. The rates of unmet needs for any FP methods were 23.9% (95% confidence interval [CI] 23.3–24.6%), 11.8% (95%CI 11.3–12.3%); 10.6% (95%CI 10.1–11.1%) at 6, 12, and 24 months postpartum; these rates for modern FP methods were 35.5% (95%CI 34.7–36.2%), 25.6% (95%CI 24.9–26.2%), and 24.6% (95%CI 23.9–25.2%), respectively. Results of 2-level logistic regression analysis showed that less-educated young women, those who had only one child or delivered by vaginal delivery at secondary hospitals, were associated with increased risk of unmet need for PPFP. Approximately 31% of women who had unmet need for PPFP reported a pregnancy during the first 24 months postpartum, which was significantly higher than the level for their counterparts (10.0%). The level of unmet need for PPFP in China was high, resulting in a high pregnancy rate within 24 months after delivery. Women’s age, education level, prior pregnancy and abortion histories, and delivery method were significantly associated with the risk of unmet need for PPFP. National PPFP guidelines that integrate PPFP services into prenatal and postnatal care are urgently needed and should be implemented throughout the country as soon as possible. PPFP services should promote the use of modern contraceptive methods.

Keywords Unmet need·Postpartum women·Family planning·Contraception·China

Website of the paper https://link.springer.com/article/10.1007/s42379-023-00127-2

Yongai Jin & Wenbo Hu Diverging destinies: changing trends of induced abortion in China

Abstract In the era of the second demographic transition, “diverging destinies” theory states that women with the most economic opportunities often obtain gains while women with the least economic opportunities suffer from losses. Using nationally representative data from the 2017 China Fertility Survey, we attempted to examine if diverging destinies theory can explain differences in the incidence of induced abortion among women with differing economic opportunities. We found that women with good economic opportunities (i.e., well-educated and holding urban hukou) were more likely to have induced abortions between 1980 and 2010 and less likely to do so between 2015 and 2017. Moreover, younger cohorts were far more likely to have induced abortions at a younger age and before marriage. These findings provide supportive evidence for diverging destinies in induced abortion scenarios in China. We thus advocate that sexual and reproductive health policy making shows an overarching concern for the interests of disadvantaged groups.

Keywords Induced abortion·Diverging destinies·China·Socio-economic status·Economic opportunities

Website of the paper https://link.springer.com/article/10.1007/s42379-023-00129-0